Influence of Stigma on Engagement in HIV Care and Adherence to Antiretroviral Therapy in Specialized HIV Clinics Targeting Men Who Have Sex with Men and Transgender Women in Lima, Peru

Affiliations

¹ Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA. david.oliveros@yale.edu.
² Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, 135 College Street, Suite 323, New Haven, CT, 06510, USA. david.oliveros@yale.edu.
³ Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
⁴ Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.
⁵ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
⁶ Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA.
⁷ Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru.
⁸ Department of Global Health, University of Washington School of Public Health, University of Washington, Seattle, WA, USA.
⁹ Department of Pediatric Dentistry, University of Washington School of Dentistry, University of Washington, Seattle, WA, USA.
¹⁰ Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru.

PMID: 38878137
DOI: 10.1007/s10461-024-04401-3

Influence of Stigma on Engagement in HIV Care and Adherence to Antiretroviral Therapy in Specialized HIV Clinics Targeting Men Who Have Sex with Men and Transgender Women in Lima, Peru

David Oliveros Gómez et al. AIDS Behav. 2024 Aug.

. 2024 Aug;28(8):2755-2768.

doi: 10.1007/s10461-024-04401-3. Epub 2024 Jun 15.

Authors

Affiliations

¹ Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA. david.oliveros@yale.edu.
² Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, 135 College Street, Suite 323, New Haven, CT, 06510, USA. david.oliveros@yale.edu.
³ Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
⁴ Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.
⁵ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
⁶ Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA.
⁷ Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru.
⁸ Department of Global Health, University of Washington School of Public Health, University of Washington, Seattle, WA, USA.
⁹ Department of Pediatric Dentistry, University of Washington School of Dentistry, University of Washington, Seattle, WA, USA.
¹⁰ Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru.

PMID: 38878137
DOI: 10.1007/s10461-024-04401-3

Abstract
in English, Spanish

HIV stigma is a social determinant of health that can influence multiple health outcomes, including adherence to antiretroviral therapy (ART), engagement in HIV care, and viral suppression levels in people with HIV (PWH). In Peru, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW), stigma may play an important role in healthcare engagement. To understand the relationship between stigma and two outcome variables, ART adherence and engagement in HIV care in 400 MSM and TGW, we assessed factors from the Behavioral Model for Vulnerable Populations at two HIV clinics that tailor services for sexual and gender minorities. While some predisposing, need, and enabling resource factors were associated with optimal (≥ 90%) ART adherence or engagement in HIV care, none of the stigma subscales were correlated, suggesting that when LGBTQ-affirming care is provided to MSM/TGW, stigma may not influence HIV-related outcomes.

El estigma hacia el VIH es un determinante social de la salud que puede influir en múltiples desenlaces, incluyendo la adherencia a la terapia antirretroviral (TAR), el compromiso con la atención del VIH y los niveles de supresión viral en personas viviendo con VIH (PVV). En el Perú, donde la epidemia del VIH se concentra en hombres que tienen sexo con hombres (HSH) y mujeres transgénero (MT), el estigma puede desempeñar un papel importante en el compromiso con la atención médica. Para comprender la relación entre el estigma y dos variables de resultado, la adherencia al TAR y el compromiso con la atención del VIH en 400 HSH y MT, evaluamos factores del Modelo de Comportamiento para Poblaciones Vulnerables en dos clínicas de VIH que adaptan sus servicios para minorías sexuales y de género. Si bien algunos factores predisponentes, de necesidad y de recursos habilitantes se asociaron con una adherencia óptima (≥ 90%) al TAR o al compromiso con la atención del VIH, ninguna de las sub-escalas de estigma estuvieron correlacionadas, sugiriendo que cuando se brinda atención que afirma a la comunidad LGBTQ a HSH/MT, el estigma puede no influir en los desenlaces relacionados con el VIH.

Keywords: Antiretroviral therapy; HIV; MSM; Stigma; Transgender women.

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Influence of Stigma on Engagement in HIV Care and Adherence to Antiretroviral Therapy in Specialized HIV Clinics Targeting Men Who Have Sex with Men and Transgender Women in Lima, Peru

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Influence of Stigma on Engagement in HIV Care and Adherence to Antiretroviral Therapy in Specialized HIV Clinics Targeting Men Who Have Sex with Men and Transgender Women in Lima, Peru

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